Impact of Choose Well initiative on Contraceptive Availability among Federally Qualified Health Centers

Authors' Affiliations

Jordan de Jong, Health Services Management and Policy Department, College of Public Health, East Tennessee State University, Johnson City, TN. Dr. Michael Smith, Health Services Management and Policy Department, College of Public Health, East Tennessee State University, Johnson City, TN. Dr. Amal Khoury, Health Services Management and Policy Department, College of Public Health, East Tennessee State University, Johnson City, TN.

Location

D.P. Culp Center Room 311

Start Date

4-5-2024 3:30 PM

End Date

4-5-2024 4:30 PM

Name of Project's Faculty Sponsor

Kate Beatty

Faculty Sponsor's Department

Health Services Management and Policy

Competition Type

Competitive

Type

Oral Presentation

Presentation Category

Health

Abstract or Artist's Statement

Introduction: Examining the factors that support or hinder the provision of contraceptives is crucial for improving contraceptive access and availability for individuals following the overturning of Roe v. Wade. Addressing the elevated rates of unintended pregnancy in the United States is a pressing public health concern. The significance of contraceptive availability plays a pivotal role in reducing unintended pregnancies, empowering reproductive autonomy, and promoting improvements in individual health, well-being, and gender equality. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. CW strategically engaged Federally Qualified Health Centers (FQHCs) as a pivotal sector in its implementation. The primary objective of CW was to collaboratively address and mitigate the existing gaps in contraceptive services by providing targeted support to FQHCs. Aim: The objective of this study is to investigate the impact of CW on the availability of contraceptive methods within FQHCs. Methods: This study compared the availability of methods between participating FQHCs in South Carolina and a non-participating group in South Carolina and a peer state . Surveys were conducted at three key time points: baseline (2016), midline (2019), and endline (2022). This allowed for an examination of changes in contraceptive availability over the course of CW. Descriptive statistics summarized survey data. Binomial regression models, utilizing a difference-in-differences approach, examined changes from 2016 to 2022 in contraceptive availability between CW-participating and non-participating clinics. Analyses were conducted using SAS version 9.4. Results: A total of 107 FQHCs at baseline, 127 at midline, and 103 at endline responded to the surveys. The results showed significant differences between CW-participating and non-participating FQHCs at various evaluation points. CW-FQHCs initially had lower availability of all CW-promoted contraceptive methods compared to non-CW FQHCs (7.1% vs. 4.4%), but by endline, CW-FQHCs surpassed non-CW-FQHCs (47.5% vs. 4.8%). Notably, CW-FQHCs consistently showed improvements in the availability of any long-acting method (intrauterine device (IUD) or implant) at midline (89.6% vs. 38.7%) and endline (92.5% vs. 30.2%). Examining the baseline to endline changes, the difference-in-difference (DiD) values showed significant differences in method availability between CW and non-CW-FQHCs. For the availability of all CW-promoted contraceptive methods, the DiD value was 0.455 (p < 0.0001), emphasizing a considerable positive shift in CW-FQHCs compared to their non-CW counterparts. Similarly, the DiD values for specific contraceptive methods such as any IUD or implant (0.315, p = 0.028), any IUD (0.447, p = 0.003), and implant (0.347, p = 0.016) showed statistically significant improvements favoring CW-FQHCs. The DiD analysis revealed notable improvements, with DiD values of 0.382 (p = 0.005) for on-site stockpiling of implants and 0.504 (p = 0.0001) for IUDs. Conclusion: The CW initiative engaged FQHCs to bridge gaps in contraceptive services. During the six years of the initiative, CW-FQHCs surpassed non-participating counterparts in contraceptive method availability, particularly IUDs and implants. The results showed substantial positive shifts, emphasizing the effectiveness of CW in enhancing contraceptive availability within participating FQHCs over the initiative's duration.

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Apr 5th, 3:30 PM Apr 5th, 4:30 PM

Impact of Choose Well initiative on Contraceptive Availability among Federally Qualified Health Centers

D.P. Culp Center Room 311

Introduction: Examining the factors that support or hinder the provision of contraceptives is crucial for improving contraceptive access and availability for individuals following the overturning of Roe v. Wade. Addressing the elevated rates of unintended pregnancy in the United States is a pressing public health concern. The significance of contraceptive availability plays a pivotal role in reducing unintended pregnancies, empowering reproductive autonomy, and promoting improvements in individual health, well-being, and gender equality. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. CW strategically engaged Federally Qualified Health Centers (FQHCs) as a pivotal sector in its implementation. The primary objective of CW was to collaboratively address and mitigate the existing gaps in contraceptive services by providing targeted support to FQHCs. Aim: The objective of this study is to investigate the impact of CW on the availability of contraceptive methods within FQHCs. Methods: This study compared the availability of methods between participating FQHCs in South Carolina and a non-participating group in South Carolina and a peer state . Surveys were conducted at three key time points: baseline (2016), midline (2019), and endline (2022). This allowed for an examination of changes in contraceptive availability over the course of CW. Descriptive statistics summarized survey data. Binomial regression models, utilizing a difference-in-differences approach, examined changes from 2016 to 2022 in contraceptive availability between CW-participating and non-participating clinics. Analyses were conducted using SAS version 9.4. Results: A total of 107 FQHCs at baseline, 127 at midline, and 103 at endline responded to the surveys. The results showed significant differences between CW-participating and non-participating FQHCs at various evaluation points. CW-FQHCs initially had lower availability of all CW-promoted contraceptive methods compared to non-CW FQHCs (7.1% vs. 4.4%), but by endline, CW-FQHCs surpassed non-CW-FQHCs (47.5% vs. 4.8%). Notably, CW-FQHCs consistently showed improvements in the availability of any long-acting method (intrauterine device (IUD) or implant) at midline (89.6% vs. 38.7%) and endline (92.5% vs. 30.2%). Examining the baseline to endline changes, the difference-in-difference (DiD) values showed significant differences in method availability between CW and non-CW-FQHCs. For the availability of all CW-promoted contraceptive methods, the DiD value was 0.455 (p < 0.0001), emphasizing a considerable positive shift in CW-FQHCs compared to their non-CW counterparts. Similarly, the DiD values for specific contraceptive methods such as any IUD or implant (0.315, p = 0.028), any IUD (0.447, p = 0.003), and implant (0.347, p = 0.016) showed statistically significant improvements favoring CW-FQHCs. The DiD analysis revealed notable improvements, with DiD values of 0.382 (p = 0.005) for on-site stockpiling of implants and 0.504 (p = 0.0001) for IUDs. Conclusion: The CW initiative engaged FQHCs to bridge gaps in contraceptive services. During the six years of the initiative, CW-FQHCs surpassed non-participating counterparts in contraceptive method availability, particularly IUDs and implants. The results showed substantial positive shifts, emphasizing the effectiveness of CW in enhancing contraceptive availability within participating FQHCs over the initiative's duration.